This document discusses behavioral health crisis response and outlines opportunities to improve services. It notes that current crisis interventions often traumatize individuals and that alternatives with better outcomes exist. A continuum of crisis services is proposed, including 23-hour beds, crisis residential services, mobile crisis teams, and peer support. Evidence suggests these services can reduce hospitalizations and lower costs while better meeting needs. The document calls for building comprehensive crisis response systems with prevention, early intervention, and crisis stabilization services. Federal funding opportunities and state/local models are also reviewed.

1. Vijay Ganju, Ph.D.
CEO, Behavioral Health Knowledge Management
vkganju@gmail.com
April 19, 2015
Behavioral Health Crisis Response:
The Reality and the Promise

2. Crisis Response as a Priority
 “Discharges from hospitals and ERs destined for
failure”
 Crisis interventions are often experience as more
traumatic than the reason for which services were
sought
 The crisis “industry” : consumers as commodities
 Burden on other social and community services
 Olmstead
 MODELS AND SERVICES WITH BETTER OUTCOMES
AND LOWER COSTS
2 Crisis Response /Vijay Ganju

3. Behavioral Health Crisis Response Services
 Continuum of services for a person experiencing a
behavioral health emergency
 Core crisis services include: 23-hour crisis
stabilization/observation beds, short term crisis
residential services and crisis stabilization, mobile
crisis services, 24/7 crisis hotlines, warm lines,
advance directives, and peer crisis services.
 The primary goals:
 to stabilize and reduce distress
 to engage individuals in appropriate treatment services
3 Crisis Response/Vijay Ganju

4. Crisis Response: The Evidence Base
 Evidence base is emergent and varies for the
different crisis services.
 23-hour Crisis Stabilization lowered rates of hospital
admissions
 Residential services may be as effective and less costly
than standard inpatient units.
 Mobile crisis are effective in diverting people from
hospitalization, linking people to outpatient services.
 Warmlines reduce use of traditional crisis services
 Peer crisis associated with better outcomes and lower
costs.
4 Crisis Response/Vijay Ganju

5. Need for Crisis Response Services
 2.2 million hospitalizations related to a mental health
diagnosis
 5.3 million Emergency Room visits related to mental
health diagnosis
 BOTTOM LINE: The need for crisis response services
is directly related to inadequacies of the community
behavioral health system.
5 Crisis Response/Vijay Ganju

6. Building a Crisis Response
Continuum
 PREVENTION – WRAP, Crisis Planning,
Housing, Employment,
Health, Peer and Family
Support
 EARLY INTERVENTION – Crisis Respite, Peer
and Family
Support, Warm Lines,
Crisis Phones
 CRISIS SERVICES – Mobile Crisis, CIT/EMS
Partnerships, 24/7 Crisis
Walk-In, 23- hour
Stabilization, Peer and Family
Support
6 Crisis Response /Vijay Ganju

7. Crisis Response –
Ten Essential Values
(SAMHSA)
 Avoiding harm
 Intervening in person-centered ways
 Shared responsibility
 Addressing trauma
 Establishing feelings of personal safety
 Based on strengths
 The whole person
 The person as credible source
 Recovery, resilience, and natural supports
 Prevention
7 Crisis Response /Vijay Ganju

8. “No Force First”
Controlling and Managing No Force First
 Full body strip search
 Uniformed security
guards 24/7
 Seclusion room
 All medications staff
administered
 Outside communication
restricted
From Lori Ashcraft and Gene Johnson,
Recovery Response Systems
 Risk-sharing discussion
 Safety through
relationship
 De-escalation techniques
 Medication self-
administration offered
Internet and email available
8 Crisis Response /Vijay Ganju

9. Some State and Local
Examples
State Models
 Arizona
 Massachusetts
 Georgia
 Delaware
 Texas
 Washington
 Oregon
 Louisiana
 Missouri
Local Models
 Maricopa Co.
 San Antonio
 Western Mass.
 Pierce Co.
 Salt Lake Co.
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10. FUNDING CRISIS SERVICES:
New Opportunities
 Medicaid:
 1915(i) Home and Community-Based Services state plan
option
 1915(c) Home and Community-Based Services waivers
 Certified Community Mental Health Centers (Section
223)
 ICARE Initiative
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11. INCREASING CRISIS ACCESS RESPONSES
EFFORTS (ICARE)
 SAMHSA FY2016 Budget Request for $10 million
 $5million – MH; $5million - SA
 Funding for crisis systems capable of preventing and
deescalating BH crises and connecting individuals
and families with post-crises services
 Program Goals: to increase the engagement with and
the functioning of individuals in crisis; increased
support for families and caregivers; decreased use of
emergency room and inpatient care; and increased
understanding by the community of BH crises.
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12. 12
CRISIS RESPONSE: The New Frontier
Traditional Crisis Recovery-Oriented Crisis
Directed, coercive
Crisis Service
“To” or “for” consumer
Reduce danger to
self or others
Crisis defined by
system perspective
Recovery-oriented;
trauma-informed
Crisis Continuum
“With” consumer
Support and safety
Crisis defined by
consumer or family perspective
Crisis Response /Vijay Ganju